Gleaning Form (Land Owner

)
Gleaning Date: 9/13/2014
Name:
_______________________________________________________________________________
Street Address/PO Box:
_________________________________________________________________
City: _______________________________ County: ________________ State: _____ Zip:
___________
Home Phone: (

) ______- ____________ Cell Phone: (

)______-____________

Work Phone: (
)______-_____________ Email:
___________________________________________
Waiver of Liability
Safety is of paramount importance in a gleaning event. For the protection
of all involved, this disclaimer is necessary.
I acknowledge that I have elected to participate in an activity that includes some
risk of injury. I do not hold Roadrunner Food Bank (RRFB), New Mexico State
University, Sandoval County Extension, the Sandoval County Master gardeners,
Seed2Need, its membership, their respective administrators, directors, agents,
officers, members, volunteers, employees and other participants (each considered
one of the "releases" herein) liable for any injury, damage, accidents or deaths on
my property during this gleaning event. I am aware that in the event of any injury,
damage, accident, or death on my property, any medical costs would have to be
covered by my home insurance.
Photo Release
Also, to encourage the continuation and expansion of gleaning events, I hereby give
anyone involved with the event, with the approval of RRFB or Seed2Need, the right
and permission to copyright and/or use, reuse and/or publish and/or republish
pictures or images of me for the purpose of illustration, advertising and promoting
gleaning events and/or participants working with and supporting RRFB and
Seed2Need in those events.

Signature: _____________________________________ ___________
_______Date:______________
(Land Owner)